Converge Highlights
Additional highlights, themes, and takeaways from Converge in 2023 and 2024
2024 Highlights (continued)
Chicago Converge Themes and Takeaways
Themes
Large scale impact results from a series of smaller steps. Rarely can system-wide changes be defined and adopted. They start at a community, practice, or even patient level. Today, we see
that approach in value-based care initiatives, which center on defined populations or health conditions, often in a smaller community setting prior to expanding. Ultimately, these initiatives
are clinical and financial proof points of new risk management models that can be priced with more certainty and applied more broadly. We can look back, similarly, at other innovations and
the seemingly slow road of adoption, such as electronic health records. Today, few can see a world where health information is not captured and shared digitally, accompanied by reduction
in medical errors and improvement in care. But the wave started small, with individual hospitals and practices, and then expanded over nearly twenty years of development, trial, and iteration.
Health inequities must be addressed in our communities. Healthcare deserts, including critical areas like maternity care, create significant disparity in wellbeing and longevity. For example, in some Chicago-area communities, particularly largely minority neighborhoods, life expectancies are as much as 16 to 30 years lower than in neighboring communities – sometimes separated by just a few blocks. Education and economic opportunity play an important role in health equity, underscoring the criticality of social determinants of health. Many showed commitment to tackling high-cost diseases and improving life expectancies in medical deserts showing a dedication to creating long-term value.
Behavioral interventions improve health outcomes. Cost and access pose significant hurdles to preventative care, particularly in the US. Thus, many people engage in behaviors that lead to high-cost diseases like diabetes, and we are managing the very costly and challenging “tail.” We will create long-term impact by taking new approaches to modifying behavioral patterns that contribute to prevention and provide the ability for people to take charge of their wellbeing.
Innovation is tied to stability in composition of impacted populations. Our Converge guests generally agreed that population stability (vs. churn) is key to implementing value-based concepts, as impact and value take longer to create and measure. Underwriting these concepts will be challenged with high population turnover, as intervention and outcome become disassociated. As a result, private insurers are reluctant to adopt new value-based concepts beyond traditional capitation or shorter-term risk sharing agreements. Medicare inherently has an advantage given the long-term enrollment of the Medicare eligible population. Nonetheless, Medicare Advantage plans have been challenged CMS reimbursement rate growth lagged both expectations and an acceleration in medical costs.
2023 Highlights
We gathered distinguished groups of leaders in three cities—Boston, Las Vegas, and San Francisco—to discuss and debate trending topics within the Quality of Life Ecosystem. Our 2023 guests included:
- Representatives from biotechnology, commercial pharma, diagnostics, device, health system, retail healthcare, managed care, and academic medicine organizations;
- Chief Executives, Board Chairs, CFOs, Commercial Officers, COOs, and People leaders;
- Private equity and venture investors;
- Consultants and advisors in digital transformation, business model development, and M&A.
The insights, knowledge, and perspectives of these leaders are sources of reflection and inspiration in our shared missions and collective work.
Themes
- Passion for change remains high, but it is shadowed by frustration. There is a high level of frustration at the state of the overall healthcare system, with many executives feeling powerless to drive change in a system structurally aligned to resist it. But our robust conversations offered insight into the passion so many executives have for impact and innovation.
- Value-based care is still viewed as the future; however, currently misaligned incentives hamper effectiveness. Although fee-for-service is widely recognized as a barrier to quality and cost optimization, value-based care is not yet working. Continued innovation is needed. Currently, value-based care constructs do not align with the incentives and KPIs predominant across the (still) largely fee-for-service system. A “bridge” is necessary to help the lion’s share of providers transition to value-based models.
- Private equity-backed healthcare is rising. So are concerns about the ability to align PE operating models with the mission-driven approach of more traditional healthcare organizations. There is an essential need to connect mission to measurable outcomes for all healthcare system participants, investors, and the community.
- Regulation is not addressing core problems. Our healthcare system, as it exists today, does not provide care equally. Single-payer systems have shown to provide more equal access to and provision of care in other industrial nations. There are however significant, perhaps insurmountable, political, economic, and structural obstacles to a national single payer system in the US. And even if these obstacles were overcome, our healthcare system would still need to address issues around timely care access and ensuring the highest quality and innovation in care.
- Steps must be taken to balance the influence of pharmacy benefit managers (PBMs). As intermediaries in drug procurement, PBMs play an outsized role in determining drug costs and accessibility, with three PBMs dominating the market and some research finding that fees demanded by PBMs are double what they were five years ago. Variability in both cost and accessibility, coupled with offerings by firms like GoodRX, create both confusion and distrust among consumers. Executives from both healthcare and life sciences spoke eloquently about the impact of PBMs on performance within their own organizations and across the ecosystem.
- Our healthcare system, as it exists today, does not provide care equally. Single-payer systems have shown to provide more equal access to and provision of care in other industrial nations. There are however significant, perhaps insurmountable, political, economic, and structural obstacles to a national single payer system in the US.
Takeaways
Our WittKieffer Converge dinner guests cannot effect meaningful change on their own. There must be greater cross-sector communication and collaboration (among developers, investors, payers, providers, educators—and lawmakers and regulators) to pave the way for more viable, sustainable value models. The current “broken” system must be addressed also to prevent irreversible talent attrition in the marketplace—especially among providers, where frustration and burnout are highest.
From a leadership perspective, executives and their organizations must continue to resist a silo mentality and engage with counterparts across the Quality of Life Ecosystem to establish greater cooperation toward viable, long-term “fixes” for structures and regulations. If leaders along the healthcare continuum work together, they can build the structures and incentives needed to improve the communities they serve.
